Eye Emergencies and First Aid: What to Do in the First Minutes

Eye emergencies are frightening, and they often happen without warning: a splash of cleaning product, a fragment of metal from a grinder, a squash ball, or a sudden shadow drifting across your vision. In many of these situations, what you do in the first few minutes, and how quickly you reach professional care, makes a real difference to how much sight is saved.

This guide explains practical first aid for the most common eye emergencies, the symptoms that should send you straight to an emergency department or eye casualty, and the common mistakes that can make things worse. It is general information, not a substitute for emergency services. If in doubt, seek help immediately: it is always better to be checked and reassured than to lose vision by waiting.

Chemical splash: rinse first, ask questions later

Chemical injuries are among the most urgent eye emergencies. Alkalis, found in oven and drain cleaners, lime, cement, plaster and some dishwasher products, are particularly dangerous because they penetrate deep into the eye tissue. Acids, such as battery acid, also cause serious burns. Every second counts.

What to do

1. Start irrigating immediately with whatever clean, lukewarm water is nearest: a tap, shower, eyewash station or bottled water. Do not waste time looking for a special solution or calling someone first.
2. Hold the eyelids open with your fingers. The eye will want to close tightly; helping it stay open is essential.
3. Rinse for at least 15 minutes, and longer for alkali or unknown chemicals. Direct the stream from the inner corner (near the nose) outwards so the water does not run into the other eye.
4. Roll the eye up, down and side to side while rinsing so the water reaches all surfaces, including under the lids.
5. Remove contact lenses if they do not come out with rinsing, then continue irrigating.
6. Go to emergency care straight afterwards, ideally continuing to rinse on the way if possible. Take the product container or a photo of its label.

Foreign body in the eye

Dust, eyelashes, sand and small insects are the usual culprits. They cause a gritty, scratchy feeling, watering and redness. Most come out with tears or a gentle rinse.

What to do

• Wash your hands before touching the area around your eye.
• Blink several times; tears often wash small particles away.
• Rinse with clean water or sterile saline, using an eye cup, a clean glass or a gentle stream from a tap.
• Pull the upper lid gently down over the lower lashes; this can sweep a particle off the inner surface of the lid.
• If you can see the particle floating on the white of the eye or on the inner lid, it may be lifted off with the moist corner of a clean tissue. Never touch the clear cornea over the coloured part of the eye.

When to seek help

• The particle is on the cornea or stuck and does not rinse away.
• The grittiness, pain or blurred vision continues after the object seems to be gone, which may mean a corneal scratch (abrasion).
• The particle hit the eye at speed, for example from hammering, grinding, drilling or mowing. High-velocity metal fragments can penetrate the eye with surprisingly little pain.
• You wear contact lenses and develop pain and redness, as this may signal an infection; see our guide on corneal ulcers and eye infections.

Blunt trauma: blows to the eye

A punch, a ball, an elbow or a fall can cause injuries ranging from a simple black eye to bleeding inside the eye, a fracture of the bony socket or a retinal tear.

First aid

• Apply a cold compress or a bag of frozen peas wrapped in a cloth to the area around the eye for 10 to 15 minutes at a time. Do not press on the eyeball itself.
• Keep the head raised to reduce swelling.
• Use simple pain relief if appropriate, but avoid medicines that increase bleeding unless your doctor advises otherwise.

Go to hospital the same day if there is

• Any change in vision, double vision or pain on moving the eye
• Blood visible in the coloured part of the eye (hyphaema), which looks like a layer of blood at the bottom of the iris
• Numbness of the cheek or upper lip, or the eye appears sunken, which may indicate a socket fracture
• New floaters, flashes or a shadow in the vision
• A pupil that looks irregular or a different size from the other
• Severe pain, nausea or vomiting

Even after an apparently minor blow, a check-up is wise, because retinal tears and raised pressure can develop days or weeks later. Our guide to eye safety at work and in sports explains how to prevent these injuries.

Cuts and penetrating eye injuries

A penetrating injury occurs when a sharp object or high-speed fragment breaks through the wall of the eye. It is a true emergency that can lead to permanent blindness or serious infection.

Signs of a possible penetrating injury

• A visible cut on the eye or eyelid, or an object sticking out of the eye
• A tear-drop or irregularly shaped pupil
• Clear or dark fluid leaking from the eye
• Sudden drop in vision after an injury involving glass, metal, wood or a sharp tool

What to do

1. Call emergency services or go directly to the nearest emergency department.
2. Cover the eye with a rigid shield, such as the bottom of a paper cup taped over the eye socket, so that it rests on the bones around the eye, not on the eyeball.
3. If possible, cover the other eye too; this reduces eye movement.
4. Keep the person calm, still and, if possible, sitting up.
5. Do not give food or drink, in case surgery is needed under general anaesthesia.

Sudden loss of vision

Painless, sudden loss of vision in one or both eyes is always an emergency. Possible causes include blockage of a retinal artery or vein, bleeding inside the eye, retinal detachment, optic nerve inflammation and stroke. In older adults, sudden visual loss with headache, scalp tenderness, jaw pain when chewing or general malaise may indicate giant cell arteritis, an inflammation of blood vessels that can quickly affect the second eye if not treated.

• If vision loss comes with weakness, numbness, facial drooping, difficulty speaking or confusion, call emergency services immediately: these are signs of stroke.
• Even if vision returns after a few minutes (transient loss of vision), you still need urgent assessment the same day, because it can be a warning of stroke.
• Do not wait to see if it improves overnight.

Flashes, floaters and a curtain over your vision

Most floaters are harmless and come from age-related changes in the gel inside the eye. However, a sudden shower of new floaters, flashes of light (especially at the edge of vision) or a dark shadow or curtain spreading across the field of vision can be signs of a retinal tear or retinal detachment. Detachment is a surgical emergency, and the chance of preserving good vision is higher if it is treated before the centre of the retina (the macula) detaches.

People with high myopia, previous eye surgery or injury, or a family history of detachment are at higher risk. Read more in our guide to floaters and flashes.

Acute painful red eye

Most red eyes are caused by mild conditions such as conjunctivitis or a burst blood vessel on the surface of the eye, which is painless and harmless. But some red eyes threaten sight.

For a deeper look at the differences, see our article red eye: harmless or an emergency?

Other situations that need prompt care

• UV and welding burns: intense pain, watering and light sensitivity several hours after exposure to welding arcs, sunbeds or snow glare. Usually heals in a day or two but should be examined.
• New double vision, especially with a droopy eyelid, headache or a large pupil, which may indicate a nerve problem or aneurysm.
• Contact lens pain: remove the lens, do not put it back, and see an eye professional the same day if pain or redness persists.
• Babies and young children with a white reflex in the pupil in photos, a sudden squint, or a swollen red eyelid with fever.

What NOT to do in an eye emergency

• Do not rub the eye.
• Do not remove an object embedded in the eye or eyelid.
• Do not apply pressure to an injured eyeball.
• Do not use tweezers, cotton buds or sharp objects on the eye surface.
• Do not put in leftover prescription drops, steroid drops or anaesthetic drops from previous treatments; anaesthetic drops delay healing and steroids can make some infections much worse.
• Do not apply home remedies such as milk, tea, breast milk, honey or herbal preparations.
• Do not drive yourself if your vision is affected or both eyes are covered.
• Do not wait to see if it gets better when the warning signs below are present.

When to go to the emergency department